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Cost of Operating Room Time is $46.04 Dollars per Minute
Tyler Scott Smith, BSA1, Justin Evans, BS1, Karla Moriel, BS1, Mikel Tihista MD1, Christopher Bacak1, John
Dunn MD1, Rajiv Rajani MD1, Benjamin Childs MD1
1) Texas Tech University Health Science Center El Paso Paul L Foster School of Medicine, El Paso, TX
JOB | @JOrthoBusiness | JOrthoBusiness.org | October 1, 2022, Vol 2, No 4 | Copyright © 2022 Journal of Orthopaedic Business Incorporated
Journal of Orthopaedic Business
Objectives: The purpose of this study is to establish a
consensus estimate of operating room cost per minute based
on currently published literature.
Design: Literature review.
Main outcome measurement: Operating room cost per unit
of time.
Results and conclusions: A Google Scholar search produced
51 articles regarding “operating room cost per minute,” of
which 14 had novel estimates for OR cost per minute. The
mean of these estimates was $46.04 ± $32.31. There was little
consistency in methodology among the included articles,
which is reflected in the large range of values.
Level of Evidence: IV; Review
Keywords: Business, management, human resources, cost,
value, efficiency.
(J Ortho Business 2022; Volume 2, Issue 4: Pages 10-13)
INTRODUCTION
Value based practice, defined as weighing the cost of
treatment against the change in patient quality of life, has
become an important consideration in treatment planning in
orthopaedic surgery 1 2 . High costs 3 4 draw the attention of
payers, while discrepancies in reimbursement disincentivize
surgeons 5 6. Ultimately what matters most is the ability to
provide better outcomes per healthcare dollar spent 7. While
significant effort is being put into measuring patient reported
outcomes 8, we must also clarify the true costs in healthcare. A
major factor of healthcare costs pertinent to the orthopaedic
surgeon is the costs associated with the operating room (OR).
The number of measurable and associated factors is vast and
remains poorly defined in the literature. This has contributed
to the ongoing controversy regarding actual cost per unit time
in the OR.
The cost to run an operating room can be divided into
direct costs such as staff wages and consumable items, indirect
costs such as building maintenance, leasing/mortgage
payments and laundry services, professional fees such as
anesthesia and surgeon fees, and specialty service fees such as
intraoperative fluoroscopy, blood bank, lab, and orthopaedic
implants9. Most of these figures can be estimated from
purchase orders and salaries payable by hospital accounting
systems 10. More recently, time driven activity-based costing
(TDABC) has allowed a more accurate way to assign cost in a
complex environment where staff are often multi-tasking and
thousands of consumables are utilized. TDABC divides
complex care into discrete cycles allowing micro-costing
assessment and assignment of cost based on time11.
In either of these methods, decisions must be made
when attempting to measure and/or conceptualize the actual
cost of a surgery. It should be noted that data in the current
literature pertaining to the cost of the operating room often12,
but not always13, excludes the costs associated with anesthesia
services, perioperative services, surgeon fees, blood bank
expenses, radiology services, and implants. Consistent data on
operating room costs is needed for effective healthcare
resource allocation. The purpose of this study is to review
available literature estimating the cost per minute of running
an operating room.
METHODS
Literature search was performed in Google Scholar
and PubMed for “operating room cost per minute”. All article
titles were reviewed by both authors, and either discarded or
selected for further review. Abstracts of selected articles were
reviewed and those that had novel estimates for operating
room cost per minute were included. Papers were excluded if
they focused on costs for procedures, considering the large
mean discrepancy in the procedural cost of an average
orthopedic procedure versus an open-heart surgery
necessitating a full team to operate a heart lung bypass
machine. The methods of the remaining articles were
scrutinized to determine what was included in the cost and
what was excluded. Where applicable, a single number was
extracted to calculate the mean cost per minute. For articles
that only reported a range, we took the median of the range
Smith et al OR cost $46 per minute
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Table 1. All estimates of OR cost per unit time found in literature.
Author
Year
OR $/min
OR $/min
inflation adj
Included
Excluded
Childers
2018
$37.45
$44.19
OR staffing, cleaning and maintenance salaries,
sterile processing, consumable supplies, recovery
room costs
Anesthesia, implants,
radiology, pathology and
blood bank
Park
2009
$20.83
$28.77
Salary and benefits, supplies, drugs, services,
depreciation
Moody
2018
$16.21
$19.13
OR staffing, medications, supplies, salaries,
equipment depreciation, training, hospital
overhead
Anesthesia, physician
services, soft goods,
implants
Shippert
2020
$62.00
$71.89
OR fees, anesthesia
Maskal
2020
$64-$115
$73- $131
Undisclosed
Anesthesia
Holloran-
Schwarts
2013
$94.14
$119.73
Support staff salaries, drapes, room maintenance,
use of non-chargeable items
Professional fees of surgeon
or anesthesia
Abbott
2007
$18.47
$26.39
Staff, heating, lighting, basic consumables
Taravella
2012
$11.24
$14.50
Hospital accountant estimate
Koehler
2016
$29.44
$36.34
Staff ($2.70/min), direct costs ($11.52/min),
overhead ($15.22/min)
Physician labor
($12.29/min)
Chapa
2010
$50
$67.94
Estimate based on published charges
Hamid
2014
$23.20
$29.03
Direct and indirect costs
Ackerman
2002
$18
$29.64
Undisclosed
Polacco
1998
$18
$32.72
Operating room use
Anesthesia staff
Gilardino
2015
$17.50
$21.88
Undisclosed
Mean
$36.14
$46.04
reported. We extracted the fiscal year for the cost estimate
when available and used the publication year when it was not.
All figures were adjusted for inflation to 2022 dollars.
RESULTS
Literature search generated a total of 51 articles.
Thirty-seven of these articles were excluded after title review.
Of this thirty-seven, twenty-eight were excluded because they
did not have novel estimates, six were excluded because they
were not peer reviewed journals, and three were excluded for
poor methodology and/or concern for quality. Of the fourteen
articles included, three were specific to orthopaedic
procedures. Five out of fourteen articles explicitly excluded
anesthesia costs and specialty service costs. The mean cost per
minute adjusted to 2022 dollars from all fourteen papers was
$46.04 per minute of OR time with a standard deviation of
$32.31.
DISCUSSION
The purpose of this study was to determine the
inflation-adjusted cost of one minute of operating room time
based on the reported data available within the current
literature. From the fourteen articles that met our inclusion
criteria, it was determined that the estimated mean inflation-
adjusted cost per minute of operating room time is $46.04 (at
the date of publication). There were several notable findings
from this review that must be considered, including vast
discrepancies in differential cost reporting, how the value of
Smith et al OR cost $46 per minute
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the operating room should be determined, and the lack of
correlation of cost to reimbursement and patient outcomes.
It was found that there was a large discrepancy with
regards to the costs measured in the reported price-per-minute
among the included articles. The majority of articles did not
include the cost of anesthesia care with the exception of one
study14. Additionally, one article included perioperative
recovery room costs15, and one included cost for trainings and
CME16. While specialty services costs such as blood bank
expenses and radiology support differ greatly by case, most
operative cases require the same anesthesia burden, and this
cost would be relevant to factor in with future studies. It was
also found that several of the articles used figures supplied by
the hospital with little mention of how the number was
calculated. This lack of rigor and varying degree of
included/excluded associated costs may contribute to the wide
range of numbers for OR cost per minute, which was found to
be from $14.50 to $131.65. This led to a standard deviation
that was 75% of the mean. With future cost assessment, it
would benefit decision makers to have a consistent way to
measure operating room costs in order to benchmark
performance and decide how to allocate resources.
Another confounding factor identified during the
current review is how to account for indirect costs such as
building maintenance for ORs that are not always in use.
Operating rooms that are dormant are significantly less
costly17, however there were few estimates for how the
vacancy rate affects the overall cost. A cost-to-profit ratio
would be helpful to determine the benefit of having and
maintaining lower volume ORs within smaller health care
facilities. This would be in contrast to larger markets where
operating rooms are used well into the night, which may
generate lower cost per minute, but the increased overhead for
support staff and services allocation would need to be adjusted
for. Understanding contributing factors and their respective
financial implication with operating room cost would better
enable appropriate resource allocation. For example, hiring
extra staff to reduce room turnover time may lead to a
reduction in overall cost, as a greater number of cases could be
done per unit time, maximizing the cost-to-profit ratio.
While this study determined the estimated inflation-
adjusted cost of the operating room per minute, there remains
a lack of correlation of this cost to care reimbursement and
patient outcomes. Further research is warranted in order to not
only extrapolate a precise, reproducible standard for how
operating room costs are measured and accounted for, but
their effect on patient outcomes.
CONCLUSION
In conclusion, the mean cost for one minute of
operating room time estimated from the literature is $46.04.
For most articles, this excludes anesthesia and specialty
services. Further research is warranted to refine methodology
and determine algorithmically a more precise and reproducible
approach to measure the cost of OR time.
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